Initial experience with endoscopic ultrasound-guided fine needle aspiration of renal masses: indications, applications and limitations

Endoscopic ultrasound-guided trans-duodenal fine-needle biopsy of a small renal mass: case report and review of the literature

Background

The incidental detection of small renal masses (SRMs) is increasing and biopsy to obtain pathological diagnosis is increasingly proposed as a diagnostic tool to guide further management. Renal mass biopsies are traditionally performed via a percutaneous approach. However, this is not always feasible due to anatomical limitations. A rarely reported alternative biopsy approach for SRMs is endoscopic ultrasound (EUS)-guided fine-needle biopsy (FNB). Herein, we describe a case of EUS-guided trans-duodenal FNB for a SRM that was not amenable to standard percutaneous biopsy.

Case presentation

A 48-year-old man was incidentally found to have a right-sided SRM measuring 2.9 × 2.2 × 2.4 cm during evaluation for a hernia. It was anterior, interpolar, completely endophytic and near the renal hilum. The tumor was not amenable to traditional percutaneous biopsy due to its anterior location. However, the renal mass was in close proximity to the descending duodenum and so it was felt that an EUS-guided trans-duodenal FNB would be feasible. The procedure was successful without any complications. The specimen adequacy was satisfactory for evaluation and consistent with renal papillary carcinoma with WHO/ISUP grade 3 nuclear changes.

Conclusion

Our case report demonstrated that EUS-guided trans-duodenal FNB was a safe and feasible approach to obtaining biopsy tissue diagnosis of a SRM that was not amenable to percutaneous biopsy.

Endoscopic ultrasound-guided fine-needle aspiration of renal lesions: experience in a tertiary center

INTRODUCTION

endoscopic ultrasound (EUS) allows the histological diagnosis of radiologically undetermined renal lesions, although few series have been described.

OBJECTIVES

to describe the procedure, yield and complications of EUS-guided renal fine-needle aspiration (FNA).

MATERIAL AND METHODS

a retrospective case series in a prospective database was used that consecutively included EUS procedures from March 2014 to August 2018. Data on complications, outcome and follow-up were collected. A successful FNA was defined as any FNA that allowed a histological diagnosis. Lesions were considered as malignant when surgically confirmed as such (the histological diagnosis was used for non-surgical patients) and benign when radiographically stable for ≥ 12 months.

RESULTS

eight patients were identified with a median age of 61.6 years (57.3-71.9), and five (62.5 %) were female. Five FNA procedures involved the right kidney and three involved the left kidney. 22G cytology needles were used. Renal FNA was diagnostic in all cases, with no complications.

CONCLUSIONS

EUS-guided FNA may represent an effective, safe procedure for the diagnosis of renal lesions of an uncertain origin.

Endoscopic ultrasound-guided trans-duodenal biopsy of a renal mass: Case report and literature review

The importance of histologic characterization of renal masses is increasing in the management of small renal tumors and metastatic settings of renal cell carcinoma (RCC). Tissue sampling of renal lesions is generally achieved through a percutaneous approach yet endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) with cytological analysis could be more suitable in selected circumstances. We report a case of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) of an anterior, mesorenal right kidney mass with a thrombus extending into the right atrium, unreachable via a percutaneous approach.

Improving ROSE: Discrepant touch preparation and histology findings in cytology of renal masses: A 10-year retrospective review

BACKGROUND

The number of "renal incidentalomas" is on the rise due to increasing use of radiologic studies. Image-guided core needle biopsies (CNB) with touch preparations are performed to guide specimen collection and triage of sample for additional studies. Results allow the clinical team to make appropriate treatment decisions.

DESIGN

Our electronic database was searched for a 10-year period to identify 180 image-guided biopsies of renal masses with rapid on-site evaluations (ROSE) and corresponding biopsy/resection specimens. Touch preparations were classified as non-diagnostic, negative/benign, adequate/positive for malignancy/oncocytic predominance, or atypical. These results were compared to the final diagnosis on the biopsy or resection specimen (if available). Diagnostic accuracy, sensitivity, specificity, and positive and negative predictive values were determined. Non-diagnostic cases and cases in which ROSE and final diagnosis were discordant were reviewed by cytopathologists blinded to the original interpretation to reconcile discrepancies and highlight interpretation pitfalls.

RESULTS

A ROSE diagnosis was rendered in 133 of 180 cases; 47 cases were non-diagnostic. Of the 133 diagnostic cases, the ROSE diagnosis was concordant with the core biopsy final diagnosis in 125 cases, yielding a diagnostic accuracy of 94%. The overall sensitivity was calculated to be 80.1%; specificity 72.4%; positive predictive value 94%; and negative predictive value 41.2%.

CONCLUSIONS

Touch preparation slides are vital but imperfect tools in evaluating renal masses. In our study, distinction between malignant and benign samples was accomplished in most cases (94% accuracy), but there are limitations. Awareness of interpretation pitfalls allows informed decisions to be made regarding specimen collection and patient management.